- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.38 / $107.38 / $109.32
| Facility | 26 | $107.38 | $107.38 | $109.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.08 / $369.01 / $520.01
| Professional | | $264.08 | $369.01 | $520.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.37 / $116.34 / $265.42
| Professional | 26 | $104.37 | $116.34 | $265.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.22 / $218.42 / $403.67
| Professional | TC | $159.22 | $218.42 | $403.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.00 / $1,786.00 / $1,786.00
| Professional | | $1,087.00 | $1,786.00 | $1,786.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $284.00 / $467.00 / $467.00
| Professional | 26 | $284.00 | $467.00 | $467.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $803.00 / $1,319.00 / $1,319.00
| Professional | TC | $803.00 | $1,319.00 | $1,319.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.75 / $670.70 / $1,230.50
| Professional | | $496.75 | $670.70 | $1,230.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $132.03 / $192.00 / $343.45
| Professional | 26 | $132.03 | $192.00 | $343.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $337.29 / $448.00 / $995.44
| Professional | TC | $337.29 | $448.00 | $995.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.37 / $792.72 / $1,732.51
| Professional | | $462.37 | $792.72 | $1,732.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.53 / $217.62 / $374.01
| Professional | 26 | $102.53 | $217.62 | $374.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $359.84 / $636.63 / $1,358.50
| Professional | TC | $359.84 | $636.63 | $1,358.50 |